Confronted with one of the most pressing public health crises of our time, our leaders and policymakers seem lost at how to address it. On the surface, it seems easy enough: simply curb the number of opioids readily available. But doing that means putting the more than one in 10 American adults suffering from chronic pain at serious risk. Fortunately for us, there is a solution. Unfortunately, however, it faces serious regulatory and business obstacles before it can be available for widespread use.
Buprenorphine is an opioid classified by the Drug Enforcement Agency as a Schedule III medication. The DEA classifies drugs between Schedules I and V based on their risk for abuse and addiction, with Schedule I having the highest risk and Schedule V the lowest. Most commonly prescribed opioid pain medications like morphine and oxycodone, however, are Schedule II drugs, and thus have a higher potential for abuse than buprenorphine.
Buprenorphine’s advantages are not limited to its comparatively lower potential for abuse though. It also has what medical literature refers to as a “ceiling effect” on the potentially fatal respiratory depression that causes many overdose deaths. For most other more commonly prescribed opioids, increased dosage carries with it an additional risk for respiratory depression. Buprenorphine’s “ceiling effect,” however, limits respiratory depression at higher dosages.
As effective as it is for the treatment of chronic pain, buprenorphine can also play an important part in combatting opioid abuse disorder caused by the more dangerous, though more frequently prescribed, alternatives. Many frequently used medications for helping treat those suffering from opioid addiction rely on buprenorphine as a critical component.
Despite the multitudinous advantages, various barriers prevent those who need buprenorphine most from obtaining it. From a bureaucratic standpoint, prescribing guidelines from the Centers for Disease Control and Prevention direct medical professionals begin treatment by prescribing riskier Schedule II drugs before moving on to Schedule III medications such as buprenorphine. These prescribing guidelines, in fact, make no meaningful distinction at all between buprenorphine and Schedule II drugs by their failure to address buprenorphine’s comparatively lower risk of abuse and addiction.
Then there are, of course, the obstacles needlessly put in place by insurance companies, who often provide little to no coverage for buprenorphine. Rather, they prefer to put in place lengthy approval processes for buprenorphine (if they have any at all), allowing it only as a last resort when cheaper, more addictive drugs like fentanyl fail. Insurance companies, when faced with the prospect of short term savings or long-term treatment, too often opt for savings. This in spite of the fact that allowing the most effective treatments as soon as possible is in the best interest of all involved parties.
It is well past time we remove these barriers to effective chronic pain treatment and allow patients the best available methods. In doing so, we will not only be helping those dealing with the scourge of chronic pain, but also helping to attack the root of the opioid epidemic: addictive pain medications. Easing access to buprenorphine is a common-sense solution, and we need to recognize this so we can begin to treat those in pain without spurring on the opioid epidemic further.
